3. Anatomy of Stomach
A muscular sac situated
between the esophagus
and small intestine.
Openings
o Gastroesophageal : To
esophagus
o Pyloric: To duodenum
6. Anatomy of Stomach
Nerve supply-
o Vagus
Blood Supply
o Left and Right Gastric
Arteries
o Splenic Artery
Venous Drainage
o Left and Right Gastric
Vein
o Splenic Vein
7. Gastric Physiology
Function of Stomach
o Temporary storage
o Digestion
o Absorption
o Gastric secretion
Two types of glands
o Gastric/ Oxyntic glands
o Pyloric glands
10. Mwajuma who is 32yrs of age complain abdominal pain for
two months now, it was of gradual onset, located at
epigastric region and radiates to the back. Over the past 4
days she vomited blood 2 times and had dark stool. On per
abdominal exam there was epigastric tenderness, other
systems were essentially normal.
a. What is your likely diagnosis
b. What are the possible causes of your diagnosis
c. What is the pathophysiology of your diagnosis
d. How will you investigate Mwajuma’s illness
e. Provide expertise management of Mwajuma’s illness
Warm up
11. PEPTIC ULCER DISEASE
An Ulcer is breaks in
mucosal surface of
stomach/ duodenum
PUD has two types
o Gastric ulcer
o Duodenal ulcer
15. Epidemiology
Gastric Ulcer
Occur later in life, peak
incidence at sixth
decades
More than half occur in
males
Unlike DUs, Gus can
represent a malignancy
Duodenal Ulcer
Occur mostly in the first
part of the duodenum
Malignant DUs are
extremely rare
34. 4. Antimicrobial drugs for H Pylori Eradication
Amoxicillin
Clarithromycin
Metronidazole
Tinidazole
Tetracycline
Treatment
35. Regime for H Pylori Eradication
Two antibiotics
& PPI
Amoxicillin 2g bid
Metronidazole 500mg td
Omeprazole 20mg bid
For 2 weeks
Lansoprazole 30mg bid
Clarithromycin 500mg bid
Tinidazole 500mg bid
2weeks
Clarithromycin 500mg bid
Metronidazole 500mg bid
Omeprazole 20mg/
lansoprazole 30md bid
for 2 weeks
36. CLINICAL SETTING RECOMMENDATION
ACTIVE ULCER
o NSAID Discontinued H2 Blocker or PPI
o NSAID Continued PPI
PROPHYLATIC THERAPY Misoprostol
PPI
Recommendation for treatment of
NSAIDS related-PUD
38. A patient presents to you with recurrent epigastric pain
that radiates to the back, more worse on later food
intake, H Pylori test is Negative and OGD shows
moderate breaks in gastric and duodenal mucosa,
which of the following is the correct treatment of this
patient?
a. Initiate two antibiotics and one PPI for 6 weeks
b. Initiate two antibiotics and one PPI for 2 weeks
c. Initiate PPI or H2 receptor blocker for 6 weeks
d. Initiate PPI or H1 receptor blocker for 4 weeks
e. Initiate PPI or H2 receptor blocker for 4 weeks
QUESTIONS
39. In the stomach lining, the parietal cells release…..and
the chief cells release….. Which both play a role in
peptic ulcer disease.
a. Pepsin, HCL
b. Pepsinogen, pepsin
c. Pepsinogen, gastric acid
d. HCL, Pepsinogen
QUESTIONS
40. You see a 47years old man in clinic with a 3 month history of
epigastric dull abdominal. He states that the pain is worse in
the mornings and relieved after meals. On direct questioning,
there is no history of weight loss and the patients has normal
bowel habits. On exam moderate discomfort on the
palpation at epigastric . What is the most likely diagnosis
a. Gastric ulcers
b. Gastro-esophageal ref lux disease
c. Duodenal ulcer
d. Gastric cancer
e. Gastritis
QUESTIONS
41. Mwajuma who is 32yrs of age complain abdominal pain
for two months now, it was of gradual onset, located at
epigastric region and radiates to the back. Over the
past 4 days she vomited blood 2 times and had dark
stool. On per abdominal exam there was epigastric
tenderness, other systems were essentially normal.
a. What is your likely diagnosis
b. What are the possible causes of your diagnosis
c. What is the pathophysiology of your diagnosis
d. How will you investigate Mwajuma’s illness
e. Provide expertise management of Mwajuma’s illness
QUESTIONS